Provider Demographics
NPI:1396838108
Name:SORENSEN, KRAIG C (DPT)
Entity Type:Individual
Prefix:
First Name:KRAIG
Middle Name:C
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10121 W CLEARWATER AVE
Mailing Address - Street 2:STE 113
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3500
Mailing Address - Country:US
Mailing Address - Phone:509-460-5588
Mailing Address - Fax:509-783-5438
Practice Address - Street 1:10121 W CLEARWATER AVE STE 113
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3500
Practice Address - Country:US
Practice Address - Phone:509-491-3807
Practice Address - Fax:509-593-5020
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0421812OtherLABOR & INDUSTRIES
WA8375362Medicaid
WAP00350500OtherRR MEDICARE
WAP00350500OtherRR MEDICARE
8855464Medicare PIN